Ophthalmology - Drugs and the eye in systemic disease Flashcards Preview

Year 4 - SPM > Ophthalmology - Drugs and the eye in systemic disease > Flashcards

Flashcards in Ophthalmology - Drugs and the eye in systemic disease Deck (14):
1

What classification system is used for hypertensive retinopathy?

Keith-Wagner classification:
1) Tortuosity and silver wiring
2) AV nipping
3) Flame haemorrhages and soft cotton wool spots
4) Papilloedema

Grades 3 and 4 = malignant hypertension

2

What granulomatous disorders can affect the eye?

TB, sarcoid, toxoplasmosis, leprosy, brucella
All of these tend to manifest as uveitis (ant/post) and choroidoretinitis

3

What systemic inflammatory conditions are associated with conjunctivitis?

SLE, reactive arthritis, IBD

4

What systemic inflammatory conditions are associated with scleritis/episcleritis?

RA, vasculitis, SLE, IBD

5

What systemic inflammatory conditions are associated with iritis?

Ank spond, IBD, sarcoid

6

What eye condition is dermatomyositis associated with?

Retinopathy

7

What is keratoconjunctivitis sicca?

This is associated with Sjogrens syndrome.
Patients have decreased tear production (as tested using Schirmer's test: <5mm in 5 min) leading to dry eyes as well as dry mouth.

Sicca syndromes can be primary (i.e. as a feature of Sjogrens) or secondary to other diseases - e.g. RA, SLE and sarcoid

Treatment is with artificial tears or saliva

8

What conditions can cause vascular occlusion of vessels in the eye?

Emboli cause amourosis fugax (transient loss of vision); associated with GCA or carotid emboli

Microemboli cause Roth spots seen typically in infective endocarditis
- these appear as a boat shaped haemorrhage with a pale centre

9

Name some metabolic conditions that cause eye changes?

Kayser-Fleischer Rings = Wilson's disease (copper accumulation)
Exophthalmos = Graves
Corneal calcification = Hyperparathyroidism (HPT)

10

How can HIV/AIDS affect the eye?

CMV retinitis - presents as "pizza pie" fundus + flames
Occurs when the CD4 count is <50
Oral ganciclovir is the treatment of choice

HIV retinopathy presents with cotton wool spots

11

What are mydriatic drugs?

Mydriasis means dilating the pupil (as opposed to miotics which constrict the pupil). Mydriatics are drugs that cause pupil dilatation.

2 broad groups of drugs cause mydriasis 1) anti-muscarinics and 2) sympathomimetic agents

1) Anti-muscarinics - block parasympathetic input to constrictor pupillae muscles on the iris carried by CN3
- Tropicamide - 3h duration
- Cyclopentolate - 24h duration; preferred for paeds

Both cause pupil dilatation and loss of light reflexes
Ciliary paralysis (cylcloplegia) causes blurred vision

2) Sympathomimetic agents - mimic sympathetic input into the eye
- parahydroxyamphetamine, phenylephrine
- may be used with tropicamide
- do NOT affect the light or accomodation reflex

Mydriatics are indicated for eye examination and to prevent synechiae in ant. uveitis/ iritis
They can cause acute glaucoma if shallow anterior chamber

12

What are miotics?

These are agents that cause pupil constriction. The most widely used agent is pilocarpine (muscarinic antagonist). They are mainly used to treat acute angle closure glaucoma.

13

What is Tetracaine?

Anaesthetic used to permit examination of a painful eye

14

Outline the drug treatment of chronic angle closure glaucoma?

1st line = beta blockers
- e.g. timolol, betaxolol
- decrease aqueous production
- caution in asthma, heart failure

2nd line = prostaglandin analogues
- e.g. lantoprost, travoprost
- increase uveoscleral outflow

3rd line = alpha agonists
- e.g. brimonidine, apraclonidine
- decrease aqueous production and increase uveoscleral outflow

Carbonic anhydrase inhibitors (used for AACG)
- e.g. dorzolamide drops, acetazolamide PO

Miotics
e.g. pilocarpine

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